Provider First Line Business Practice Location Address:
1272 WEST MAIN STREET BLDG 2 STE. 2
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-348-1760
Provider Business Practice Location Address Fax Number:
740-348-1761
Provider Enumeration Date:
03/05/2012