Provider First Line Business Practice Location Address:
805 MAHONING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44502-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-747-3541
Provider Business Practice Location Address Fax Number:
330-744-3936
Provider Enumeration Date:
04/25/2007