Provider First Line Business Practice Location Address:
1051 HUSBAND RD
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:
42003-0204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-443-0957
Provider Business Practice Location Address Fax Number:
270-443-6044
Provider Enumeration Date:
11/22/2006