Provider First Line Business Practice Location Address:
74 S. 2ND STREET
Provider Second Line Business Practice Location Address:
P.O. BOX 5030
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43058-5030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-670-8837
Provider Business Practice Location Address Fax Number:
740-670-8993
Provider Enumeration Date:
04/01/2019