Provider First Line Business Practice Location Address:
144 EAST MAIN STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-385-1881
Provider Business Practice Location Address Fax Number:
740-385-1875
Provider Enumeration Date:
01/15/2016