Provider First Line Business Practice Location Address:
4000 LOGAN GATE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44505-1773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-304-0089
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2020