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:
740-618-0552
Provider Business Practice Location Address Fax Number:
740-345-3697
Provider Enumeration Date:
02/14/2019