Provider First Line Business Practice Location Address:
221 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45662-3831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-351-0500
Provider Business Practice Location Address Fax Number:
740-351-0550
Provider Enumeration Date:
10/25/2005