Provider First Line Business Practice Location Address:
112 S 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43055-5335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-345-6874
Provider Business Practice Location Address Fax Number:
740-345-5157
Provider Enumeration Date:
12/06/2024