Provider First Line Business Practice Location Address:
20017 STATE ROUTE 93 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43138-8781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-385-2461
Provider Business Practice Location Address Fax Number:
740-385-8499
Provider Enumeration Date:
09/20/2006