Provider First Line Business Practice Location Address:
1620 KENTUCKY AVE
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:
42003-2851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-442-7121
Provider Business Practice Location Address Fax Number:
270-443-9692
Provider Enumeration Date:
07/31/2019