Provider First Line Business Practice Location Address:
725 LOGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINGO JUNCTION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43938-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-219-1028
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2026