Provider First Line Business Practice Location Address:
2601 KENTUCKY AVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-3817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-575-3113
Provider Business Practice Location Address Fax Number:
270-575-3588
Provider Enumeration Date:
12/18/2012