Provider First Line Business Practice Location Address:
1010 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43138-1057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-385-0593
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2007