Provider First Line Business Practice Location Address:
67800 MALL RING ROAD
Provider Second Line Business Practice Location Address:
C/O SEARS
Provider Business Practice Location Address City Name:
ST. CLAIRSVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-695-5535
Provider Business Practice Location Address Fax Number:
740-695-5958
Provider Enumeration Date:
09/25/2008