Provider First Line Business Practice Location Address:
91 W SECOND STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-385-2094
Provider Business Practice Location Address Fax Number:
740-385-9833
Provider Enumeration Date:
06/07/2006