Provider First Line Business Practice Location Address:
1500 COSHOCTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43050-1475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-392-5152
Provider Business Practice Location Address Fax Number:
740-392-1279
Provider Enumeration Date:
06/12/2012