Provider First Line Business Practice Location Address:
1045 S GUM SPRINGS 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:
42001-9299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-554-6656
Provider Business Practice Location Address Fax Number:
270-441-4370
Provider Enumeration Date:
02/13/2009