Provider First Line Business Practice Location Address:
122 SOUTH MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UTICA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43080-0541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-892-4622
Provider Business Practice Location Address Fax Number:
740-892-4622
Provider Enumeration Date:
12/13/2006