Provider First Line Business Practice Location Address:
809 COSHOCTON AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43050-3543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-397-7971
Provider Business Practice Location Address Fax Number:
740-397-5728
Provider Enumeration Date:
12/31/2008