Provider First Line Business Practice Location Address:
222 N OAKLAND AVE
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:
43160-1234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-335-0149
Provider Business Practice Location Address Fax Number:
740-335-3489
Provider Enumeration Date:
12/06/2005