Provider First Line Business Practice Location Address:
90 N 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 23
Provider Business Practice Location Address City Name:
MARTINS FERRY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43935-1648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-633-1921
Provider Business Practice Location Address Fax Number:
740-633-2334
Provider Enumeration Date:
05/10/2006