Provider First Line Business Practice Location Address:
2312 KENTUCKY AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-442-5151
Provider Business Practice Location Address Fax Number:
855-656-7325
Provider Enumeration Date:
06/13/2005