Provider First Line Business Practice Location Address:
496 GLENWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44502-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-743-2772
Provider Business Practice Location Address Fax Number:
330-743-2238
Provider Enumeration Date:
01/24/2007