Provider First Line Business Practice Location Address:
162 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43713-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-425-3329
Provider Business Practice Location Address Fax Number:
740-619-0214
Provider Enumeration Date:
01/27/2008