Provider First Line Business Practice Location Address:
1005 E TEMPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON COURT HOUSE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43160-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-208-2550
Provider Business Practice Location Address Fax Number:
740-853-4229
Provider Enumeration Date:
01/23/2006