Provider First Line Business Practice Location Address:
1369 E FRONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43138-9031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-385-4371
Provider Business Practice Location Address Fax Number:
740-380-1464
Provider Enumeration Date:
10/29/2013