Provider First Line Business Practice Location Address:
1220 YAUGER RD
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:
43050-9233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-263-7036
Provider Business Practice Location Address Fax Number:
740-399-3753
Provider Enumeration Date:
06/30/2006