Provider First Line Business Practice Location Address: 
1440 S CANFIELD NILES RD STE B
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
AUSTINTOWN
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44515-4087
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
234-264-8080
    Provider Business Practice Location Address Fax Number: 
234-264-8066
    Provider Enumeration Date: 
07/01/2011