Provider First Line Business Practice Location Address:
SHAPE CLINIC, PUTNAM HALL 304
Provider Second Line Business Practice Location Address:
96 E UNION ST
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-593-1829
Provider Business Practice Location Address Fax Number:
740-593-0289
Provider Enumeration Date:
11/22/2006