Provider First Line Business Practice Location Address:
148 STATE ROUTE 775
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROCTORVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45669-8839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-886-7000
Provider Business Practice Location Address Fax Number:
740-886-5518
Provider Enumeration Date:
10/11/2006