Provider First Line Business Practice Location Address:
2345 NEW HOLT 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:
42001-7404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-554-0378
Provider Business Practice Location Address Fax Number:
270-554-3040
Provider Enumeration Date:
11/07/2006