Provider First Line Business Practice Location Address:
408 E COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON CH
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-335-4129
Provider Business Practice Location Address Fax Number:
740-335-9625
Provider Enumeration Date:
01/18/2006