Provider First Line Business Practice Location Address:
2379 NEW HOLT ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-441-4777
Provider Business Practice Location Address Fax Number:
270-441-4780
Provider Enumeration Date:
04/27/2021