Provider First Line Business Practice Location Address:
150 N 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:
42001-5602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-554-1904
Provider Business Practice Location Address Fax Number:
270-554-1905
Provider Enumeration Date:
02/26/2007