Provider First Line Business Practice Location Address:
50-A CENTER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUCASVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45648-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-259-2442
Provider Business Practice Location Address Fax Number:
740-259-9341
Provider Enumeration Date:
01/31/2007