Provider First Line Business Practice Location Address:
722 COMMERCIAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINGO JCT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43938-1066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-535-1182
Provider Business Practice Location Address Fax Number:
740-535-1648
Provider Enumeration Date:
07/17/2006