Provider First Line Business Practice Location Address:
3367 COUNTY ROAD 550
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45628-9503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-998-6817
Provider Business Practice Location Address Fax Number:
740-998-2359
Provider Enumeration Date:
09/23/2026