Provider First Line Business Practice Location Address: 
1309 NORTON AVE
    Provider Second Line Business Practice Location Address: 
STE. 100
    Provider Business Practice Location Address City Name: 
NORTON
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44203-9517
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
330-825-2355
    Provider Business Practice Location Address Fax Number: 
330-706-0231
    Provider Enumeration Date: 
11/16/2009