Provider First Line Business Practice Location Address:
149 S FRIENDSHIP 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:
42003-5736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-551-5245
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2026