Provider First Line Business Practice Location Address:
614 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:
42003-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-442-5156
Provider Business Practice Location Address Fax Number:
270-443-3603
Provider Enumeration Date:
08/27/2006