Provider First Line Business Practice Location Address:
1145 E TEMPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON COURT HOUSE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43160-1664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-636-0202
Provider Business Practice Location Address Fax Number:
740-636-0203
Provider Enumeration Date:
01/25/2006