Provider First Line Business Practice Location Address:
408 S 28TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-3808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-444-4041
Provider Business Practice Location Address Fax Number:
270-444-7319
Provider Enumeration Date:
08/22/2011