Provider First Line Business Practice Location Address:
5208 MAHONING AVE
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44515-1858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-799-9270
Provider Business Practice Location Address Fax Number:
330-799-2295
Provider Enumeration Date:
01/03/2007