Provider First Line Business Practice Location Address:
460 LOGAN ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JUNCTION CITY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43748-9651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-987-8123
Provider Business Practice Location Address Fax Number:
740-987-8393
Provider Enumeration Date:
04/02/2007