Provider First Line Business Practice Location Address:
1138 CASTLE 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:
45662-5331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-776-6011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2007