Provider First Line Business Practice Location Address:
LICKING MEMORIAL FAMILY PRACTICE EAST
Provider Second Line Business Practice Location Address:
399 E. MAIN ST
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
220-564-1846
Provider Business Practice Location Address Fax Number:
220-564-1847
Provider Enumeration Date:
07/10/2006