Provider First Line Business Practice Location Address:
370 W CHURCH ST
Provider Second Line Business Practice Location Address:
JOHNSTOWN
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43055-4239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-975-4915
Provider Business Practice Location Address Fax Number:
186-684-5640
Provider Enumeration Date:
02/17/2012