Provider First Line Business Practice Location Address:
201 203 MCLISTEN AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-535-0555
Provider Business Practice Location Address Fax Number:
740-535-2020
Provider Enumeration Date:
11/30/2006