Provider First Line Business Practice Location Address:
116 S COMMERCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45338-0697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-962-4640
Provider Business Practice Location Address Fax Number:
937-962-4545
Provider Enumeration Date:
08/16/2005