Provider First Line Business Practice Location Address:
318 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW LEXINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43764-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-342-3922
Provider Business Practice Location Address Fax Number:
740-342-9983
Provider Enumeration Date:
02/04/2008