Provider First Line Business Practice Location Address: 
415 S PORTAGE PATH
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
AKRON
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44320-2327
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
330-253-4597
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/03/2013