Provider First Line Business Practice Location Address:
10 E LOCUST 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:
43055-5530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-345-8644
Provider Business Practice Location Address Fax Number:
740-345-3325
Provider Enumeration Date:
07/17/2006