Provider First Line Business Practice Location Address:
3206 IRVIN COBB DR
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:
42003-0337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-442-2202
Provider Business Practice Location Address Fax Number:
270-442-1282
Provider Enumeration Date:
01/08/2010