Provider First Line Business Practice Location Address:
200 LIVINGSTON WAY
Provider Second Line Business Practice Location Address:
DENISON UNIVERSITY DEPARTMENT OF PHYSICAL EDUCATION
Provider Business Practice Location Address City Name:
GRANVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-587-6311
Provider Business Practice Location Address Fax Number:
740-587-5742
Provider Enumeration Date:
05/08/2007