Provider First Line Business Practice Location Address: 
766 E EXCHANGE STREET
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
AKRON
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44306-1059
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
330-376-8628
    Provider Business Practice Location Address Fax Number: 
330-376-8629
    Provider Enumeration Date: 
11/13/2006