Provider First Line Business Practice Location Address:
1650 COSHOCTON AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43050-1547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-392-2000
Provider Business Practice Location Address Fax Number:
740-392-2002
Provider Enumeration Date:
02/26/2007