Provider First Line Business Practice Location Address:
158 E MAIN 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:
43138-1387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-385-4006
Provider Business Practice Location Address Fax Number:
740-385-4043
Provider Enumeration Date:
03/29/2007