Provider First Line Business Practice Location Address:
548 CLINTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON COURT HOUSE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43160-1203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-335-4062
Provider Business Practice Location Address Fax Number:
740-333-3833
Provider Enumeration Date:
07/15/2021