Provider First Line Business Practice Location Address:
1249 COUNTY ROAD 19
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINGO JUNCTION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43938-7915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-598-2054
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2026