Provider First Line Business Practice Location Address:
1509 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43055-1826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-344-8692
Provider Business Practice Location Address Fax Number:
740-344-8691
Provider Enumeration Date:
03/22/2007