Provider First Line Business Practice Location Address: 
95 ARCH ST
    Provider Second Line Business Practice Location Address: 
SUITE 165
    Provider Business Practice Location Address City Name: 
AKRON
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44304-1437
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
330-375-4848
    Provider Business Practice Location Address Fax Number: 
330-376-4066
    Provider Enumeration Date: 
03/01/2006