Provider First Line Business Practice Location Address:
101 LONGVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINGO JUNCTION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43938-1454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-282-5335
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2005