Provider First Line Business Practice Location Address:
267 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-967-7896
Provider Business Practice Location Address Fax Number:
740-927-6463
Provider Enumeration Date:
11/03/2005