Provider First Line Business Practice Location Address:
1115 CLARK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43725-1635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-255-5214
Provider Business Practice Location Address Fax Number:
740-453-2733
Provider Enumeration Date:
01/03/2011