Provider First Line Business Practice Location Address:
2465 NEW HOLT ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-366-0735
Provider Business Practice Location Address Fax Number:
270-366-0777
Provider Enumeration Date:
07/21/2009