Provider First Line Business Practice Location Address:
77 N HIGH ST
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:
43138-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-277-5769
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2009