Provider First Line Business Practice Location Address:
1101 CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COSHOCTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43812-1323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-622-3553
Provider Business Practice Location Address Fax Number:
740-622-5270
Provider Enumeration Date:
01/31/2007