Provider First Line Business Practice Location Address:
50 S COURT ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45701-2810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-593-7493
Provider Business Practice Location Address Fax Number:
740-593-0533
Provider Enumeration Date:
09/20/2006