Provider First Line Business Practice Location Address: 
1800 SINCLAIR AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
STEUBENVILLE
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
43953-3328
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
740-264-7301
    Provider Business Practice Location Address Fax Number: 
740-266-3164
    Provider Enumeration Date: 
09/29/2009