Provider First Line Business Practice Location Address:
5617 SCHOOL HOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRAZEYSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43822-9731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-683-9557
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2026