Provider First Line Business Practice Location Address:
504 HOWARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43912-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-635-1535
Provider Business Practice Location Address Fax Number:
740-635-0038
Provider Enumeration Date:
10/27/2016