Provider First Line Business Practice Location Address:
867 MCGUIRE AVE
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:
42001-4036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-442-6168
Provider Business Practice Location Address Fax Number:
270-443-6211
Provider Enumeration Date:
05/20/2012