Provider First Line Business Practice Location Address:
1800 N WATER STREET EXT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UHRICHSVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44683-1044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-922-6888
Provider Business Practice Location Address Fax Number:
740-388-6689
Provider Enumeration Date:
05/18/2006