Provider First Line Business Practice Location Address:
822 PRINCETON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZANESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43701-1860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-452-6396
Provider Business Practice Location Address Fax Number:
740-450-0004
Provider Enumeration Date:
12/28/2005