Provider First Line Business Practice Location Address:
745 E MAIN ST
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:
43055-6932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-670-5180
Provider Business Practice Location Address Fax Number:
740-670-5183
Provider Enumeration Date:
10/14/2026