Provider First Line Business Practice Location Address:
410 W HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43050-2325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-393-0202
Provider Business Practice Location Address Fax Number:
740-392-9700
Provider Enumeration Date:
09/20/2005