Provider First Line Business Practice Location Address:
138 N 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEPORT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45760-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-592-6720
Provider Business Practice Location Address Fax Number:
740-592-6728
Provider Enumeration Date:
03/09/2006