Provider First Line Business Practice Location Address:
75 W 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43138-1886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-380-9355
Provider Business Practice Location Address Fax Number:
740-380-2273
Provider Enumeration Date:
06/19/2006