Provider First Line Business Practice Location Address:
1505 CLARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-432-5398
Provider Business Practice Location Address Fax Number:
740-432-8905
Provider Enumeration Date:
11/16/2006