Provider First Line Business Practice Location Address:
2200 WASHINGTON 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:
42003-3256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-347-2534
Provider Business Practice Location Address Fax Number:
870-301-2092
Provider Enumeration Date:
12/11/2006