Provider First Line Business Practice Location Address:
54912 TEMPERANCEVILLE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43713-9650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-679-3417
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2007