Provider First Line Business Practice Location Address:
110 COSHOCTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43050-2628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-392-4000
Provider Business Practice Location Address Fax Number:
740-392-6379
Provider Enumeration Date:
12/21/2006