Provider First Line Business Practice Location Address:
1605 N FRIENDSHIP RD
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:
42001-8650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-534-4422
Provider Business Practice Location Address Fax Number:
270-534-4409
Provider Enumeration Date:
05/21/2007