Provider First Line Business Practice Location Address:
2000 KENTUCKY AVE
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:
42003-3202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-444-9011
Provider Business Practice Location Address Fax Number:
270-444-9902
Provider Enumeration Date:
02/09/2007