Provider First Line Business Practice Location Address:
1311 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43055-1821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-348-0012
Provider Business Practice Location Address Fax Number:
740-348-0045
Provider Enumeration Date:
05/02/2013