Provider First Line Business Practice Location Address:
1204 COLUMBUS 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:
43160-1655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-335-0000
Provider Business Practice Location Address Fax Number:
740-335-8888
Provider Enumeration Date:
02/27/2007