Provider First Line Business Practice Location Address:
WELLWORKS GROVER CENTER E 144
Provider Second Line Business Practice Location Address:
OHIO UNIVERSITY
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
749-593-0250
Provider Business Practice Location Address Fax Number:
740-593-0170
Provider Enumeration Date:
01/29/2009