Provider First Line Business Practice Location Address:
2603 KENTUCKY AVE
Provider Second Line Business Practice Location Address:
STE 404
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-3814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-443-6472
Provider Business Practice Location Address Fax Number:
270-442-1649
Provider Enumeration Date:
06/01/2005