Provider First Line Business Practice Location Address:
1215 NEWARK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZANESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43701-2861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-452-7359
Provider Business Practice Location Address Fax Number:
740-452-7309
Provider Enumeration Date:
10/11/2005