Provider First Line Business Practice Location Address:
204 S 19TH 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:
42003-2822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-444-6774
Provider Business Practice Location Address Fax Number:
270-444-0162
Provider Enumeration Date:
02/13/2007