Provider First Line Business Practice Location Address:
116 MCLISTER AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MINGO JUNCTION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43938-1259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-535-8025
Provider Business Practice Location Address Fax Number:
740-535-8079
Provider Enumeration Date:
02/10/2015