Provider First Line Business Practice Location Address:
406 W. PLUM STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-378-6041
Provider Business Practice Location Address Fax Number:
937-378-2321
Provider Enumeration Date:
11/17/2010