Provider First Line Business Practice Location Address:
8423 MARKET ST STE 300
Provider Second Line Business Practice Location Address:
BOARDMAN MEDICAL PAVILION
Provider Business Practice Location Address City Name:
BOARDMAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44512-6778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-729-1145
Provider Business Practice Location Address Fax Number:
330-729-1144
Provider Enumeration Date:
10/01/2006