Provider First Line Business Practice Location Address:
113 1/2 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 9
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:
43160-2289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-333-0300
Provider Business Practice Location Address Fax Number:
614-885-6188
Provider Enumeration Date:
10/06/2006