Provider First Line Business Practice Location Address:
250 S GLENN 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:
43160-1712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-335-6391
Provider Business Practice Location Address Fax Number:
740-335-3531
Provider Enumeration Date:
08/31/2009