Provider First Line Business Practice Location Address:
1415 ORANGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COSHOCTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43812-2230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-622-3668
Provider Business Practice Location Address Fax Number:
740-622-4696
Provider Enumeration Date:
02/20/2007