Provider First Line Business Practice Location Address:
619 N 30TH 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:
42001-4047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-444-7898
Provider Business Practice Location Address Fax Number:
270-933-1786
Provider Enumeration Date:
10/26/2023