Provider First Line Business Practice Location Address:
2200 WASHINGTON 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:
42003-3256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-575-3247
Provider Business Practice Location Address Fax Number:
270-442-7335
Provider Enumeration Date:
04/21/2014