Provider First Line Business Practice Location Address: 
2823 9TH ST. SW
    Provider Second Line Business Practice Location Address: 
CEDAR SCHOOL
    Provider Business Practice Location Address City Name: 
CANTON
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44710
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
330-580-3502
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
11/12/2014