Provider First Line Business Practice Location Address:
798 E MAIN 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:
43138-1740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-304-7826
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2010