Provider First Line Business Practice Location Address:
1927 IRVIN COBB DR
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-442-6617
Provider Business Practice Location Address Fax Number:
270-442-0089
Provider Enumeration Date:
07/27/2006