Provider First Line Business Practice Location Address: 
200 E. STATE STREET
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ALLIANCE
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44601
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
330-596-6000
    Provider Business Practice Location Address Fax Number: 
330-596-7214
    Provider Enumeration Date: 
03/01/2006