Provider First Line Business Practice Location Address:
15047 FIRST ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARBON HILL
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43111-0091
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-753-9357
Provider Business Practice Location Address Fax Number:
740-753-9571
Provider Enumeration Date:
08/11/2006