Provider First Line Business Practice Location Address:
340 W COSHOCTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43031-1113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-967-5931
Provider Business Practice Location Address Fax Number:
740-967-8192
Provider Enumeration Date:
07/21/2006