Provider First Line Business Practice Location Address:
1330 COSHOCTON AVE
Provider Second Line Business Practice Location Address:
ROOM 221
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43050-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-393-9147
Provider Business Practice Location Address Fax Number:
740-399-3161
Provider Enumeration Date:
05/16/2008