Provider First Line Business Practice Location Address:
134 W 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICKTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43019-1035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-694-2956
Provider Business Practice Location Address Fax Number:
740-694-0956
Provider Enumeration Date:
06/28/2007