Provider First Line Business Practice Location Address:
20 S 29TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43055-2565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-344-6995
Provider Business Practice Location Address Fax Number:
740-344-9423
Provider Enumeration Date:
08/20/2006