Provider First Line Business Practice Location Address: 
232 NORTHWEST AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
TALLMADGE
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44278-1853
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
330-319-3303
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
03/14/2013