Provider First Line Business Practice Location Address:
1828 STATE ROUTE 728
Provider Second Line Business Practice Location Address:
BOARD OF EDUCATION OFFICE
Provider Business Practice Location Address City Name:
LUCASVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45648-8469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-259-3115
Provider Business Practice Location Address Fax Number:
740-259-3822
Provider Enumeration Date:
06/29/2007