Provider First Line Business Practice Location Address: 
95 W WATERLOO RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
AKRON
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44319-1131
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
330-724-7715
    Provider Business Practice Location Address Fax Number: 
330-724-1080
    Provider Enumeration Date: 
08/10/2009