Provider First Line Business Practice Location Address:
2320 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-442-1223
Provider Business Practice Location Address Fax Number:
270-442-1223
Provider Enumeration Date:
09/07/2006