Provider First Line Business Practice Location Address:
3025 CLAY ST
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:
42001-4071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-443-1317
Provider Business Practice Location Address Fax Number:
270-443-1369
Provider Enumeration Date:
07/08/2014