Provider First Line Business Practice Location Address:
102 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43713-1066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-425-2651
Provider Business Practice Location Address Fax Number:
740-425-9002
Provider Enumeration Date:
09/16/2005