Provider First Line Business Practice Location Address:
1616 COVINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44510-1244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-747-9215
Provider Business Practice Location Address Fax Number:
330-747-9248
Provider Enumeration Date:
03/07/2007