Provider First Line Business Practice Location Address: 
1009 STEUBENVILLE AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
CAMBRIDGE
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
43725-2401
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
740-439-4532
    Provider Business Practice Location Address Fax Number: 
740-439-1031
    Provider Enumeration Date: 
07/24/2023