Provider First Line Business Practice Location Address:
2605 KENUTCKY AVE
Provider Second Line Business Practice Location Address:
SUITE 3 BLDG 3
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-443-7534
Provider Business Practice Location Address Fax Number:
270-442-0309
Provider Enumeration Date:
05/26/2005