Provider First Line Business Practice Location Address:
718 LEIBERMAN 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:
42003-0121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-441-7924
Provider Business Practice Location Address Fax Number:
270-441-7924
Provider Enumeration Date:
09/01/2016