Provider First Line Business Practice Location Address:
71 S TERRACE AVE
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:
43055-1355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-281-3205
Provider Business Practice Location Address Fax Number:
740-281-3743
Provider Enumeration Date:
10/24/2007