Provider First Line Business Practice Location Address:
1600 PEMBROKE OAK GROVE RD
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:
42266-9760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-887-7290
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2009