Provider First Line Business Practice Location Address:
1165 S LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANAL FULTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44614-1075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-854-2456
Provider Business Practice Location Address Fax Number:
330-854-0619
Provider Enumeration Date:
08/31/2006