Provider First Line Business Practice Location Address:
225 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:
43138-1305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-380-9537
Provider Business Practice Location Address Fax Number:
740-380-1488
Provider Enumeration Date:
08/11/2006