WILLIS K FUQUA

PADUCAH, KY
NPI1801950803
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center)
Enumeration Date2006-12-21
Last Update Date2009-02-24
Business Address
WILLIS K FUQUA
425 BROADWAY ST
PADUCAH, KY 42001-0713
Phone number: 270-442-7121
Mailing Address
WILLIS K FUQUA
425 BROADWAY
PADUCAH, KY 42001
Phone number:
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