Provider First Line Business Practice Location Address:
1147 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43130-4056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-687-9173
Provider Business Practice Location Address Fax Number:
740-689-3740
Provider Enumeration Date:
01/25/2008