Provider First Line Business Practice Location Address:
2021 COLUMBUS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON COURT HOUSE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43160-9094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-333-7848
Provider Business Practice Location Address Fax Number:
740-333-1212
Provider Enumeration Date:
02/12/2007