Provider First Line Business Practice Location Address:
32 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43031-1225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-967-0303
Provider Business Practice Location Address Fax Number:
740-967-2332
Provider Enumeration Date:
04/06/2007