Provider First Line Business Practice Location Address: 
614 ABINGTON RD
    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: 
44312-2425
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
330-310-8282
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/17/2011