Provider First Line Business Practice Location Address:
1122 COLUMBUS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON COURT HOUSE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43160-1653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-335-9900
Provider Business Practice Location Address Fax Number:
740-335-6390
Provider Enumeration Date:
10/19/2005