Provider First Line Business Practice Location Address:
1851 STATE ROUTE 56
Provider Second Line Business Practice Location Address:
MADISON CORRECTIONAL INSTITUTION
Provider Business Practice Location Address City Name:
LONDON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-852-9777
Provider Business Practice Location Address Fax Number:
740-852-3666
Provider Enumeration Date:
07/16/2014