Provider First Line Business Practice Location Address:
412 ADAMS ST
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:
42003-1537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-442-3988
Provider Business Practice Location Address Fax Number:
270-442-4645
Provider Enumeration Date:
08/04/2006