Provider First Line Business Practice Location Address:
498 W HUNTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43138-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-385-4017
Provider Business Practice Location Address Fax Number:
740-385-7666
Provider Enumeration Date:
11/07/2006