Provider First Line Business Practice Location Address:
6272 COUNTY ROAD 107 STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROCTORVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45669-9243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-867-2200
Provider Business Practice Location Address Fax Number:
740-867-2203
Provider Enumeration Date:
07/19/2017