Provider First Line Business Practice Location Address:
4465 CLARKS RIVER 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:
42003-0822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-217-5749
Provider Business Practice Location Address Fax Number:
270-582-1192
Provider Enumeration Date:
11/06/2025