Provider First Line Business Practice Location Address:
120 S VINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIANA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-482-3816
Provider Business Practice Location Address Fax Number:
330-482-4113
Provider Enumeration Date:
11/03/2006