Provider First Line Business Practice Location Address:
42 E 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRAZEYSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43822-9651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-828-1020
Provider Business Practice Location Address Fax Number:
740-828-9089
Provider Enumeration Date:
12/14/2005