Provider First Line Business Practice Location Address:
1649 GRANVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43055-1535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-344-2191
Provider Business Practice Location Address Fax Number:
740-344-6308
Provider Enumeration Date:
01/02/2007