Provider First Line Business Practice Location Address: 
395 N 15TH
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
SEBRING
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44672
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
330-938-3384
    Provider Business Practice Location Address Fax Number: 
330-938-2817
    Provider Enumeration Date: 
06/22/2006