Provider First Line Business Practice Location Address:
MARIAN CLARK CTR.
Provider Second Line Business Practice Location Address:
1183 BELLEFONTAINE AVE.
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44301-0779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-383-2154
Provider Business Practice Location Address Fax Number:
740-387-3407
Provider Enumeration Date:
06/12/2007