Provider First Line Business Practice Location Address:
2701 JEFFERSON 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:
42001-3169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-227-9950
Provider Business Practice Location Address Fax Number:
270-415-3496
Provider Enumeration Date:
08/27/2007