Provider First Line Business Practice Location Address:
809 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON COURT HOUSE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43160-2053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-333-7116
Provider Business Practice Location Address Fax Number:
740-333-7116
Provider Enumeration Date:
09/15/2011