Provider First Line Business Practice Location Address: 
302 BUCHTEL MALL
    Provider Second Line Business Practice Location Address: 
INFOCISION STADIUM 307G
    Provider Business Practice Location Address City Name: 
AKRON
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44325-5103
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
330-972-8499
    Provider Business Practice Location Address Fax Number: 
330-972-5293
    Provider Enumeration Date: 
10/05/2012