Provider First Line Business Practice Location Address:
1520 CALIFORNIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-581-3681
Provider Business Practice Location Address Fax Number:
330-875-1451
Provider Enumeration Date:
10/17/2007