Provider First Line Business Practice Location Address:
126 WEST CHURCH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43055-5033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-345-5190
Provider Business Practice Location Address Fax Number:
740-345-5099
Provider Enumeration Date:
06/19/2007