Provider First Line Business Practice Location Address:
620 W COSHOCTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43031-9580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-967-2225
Provider Business Practice Location Address Fax Number:
740-967-8907
Provider Enumeration Date:
02/23/2009