Provider First Line Business Practice Location Address:
232 DEWEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-364-7272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2020