Provider First Line Business Practice Location Address:
2 COMMERCIAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON CT HS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-335-2921
Provider Business Practice Location Address Fax Number:
740-335-5664
Provider Enumeration Date:
09/22/2006