Provider First Line Business Practice Location Address:
820 S NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON COURT HOUSE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43160-2262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-696-0001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2009