Provider First Line Business Practice Location Address:
100 MARSHALL COURT
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:
42001-4075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-442-6884
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2006