Provider First Line Business Practice Location Address:
EASTWAY DR
Provider Second Line Business Practice Location Address:
KENT STATE UNIVERSITY - DEWEESE HEALTH CENTER
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44242-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-672-8245
Provider Business Practice Location Address Fax Number:
330-672-3711
Provider Enumeration Date:
09/07/2011