Provider First Line Business Practice Location Address:
117 E MULBERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43105-1333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-862-3154
Provider Business Practice Location Address Fax Number:
740-862-3186
Provider Enumeration Date:
06/08/2005