Provider First Line Business Practice Location Address:
127 SOUTH PROSPECT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-587-1136
Provider Business Practice Location Address Fax Number:
740-587-1137
Provider Enumeration Date:
02/26/2007