Provider First Line Business Practice Location Address:
420 GRANVILLE 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:
43055-4345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-344-1201
Provider Business Practice Location Address Fax Number:
740-344-1298
Provider Enumeration Date:
09/28/2006