Provider First Line Business Practice Location Address:
936 9TH STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-935-1482
Provider Business Practice Location Address Fax Number:
740-876-4026
Provider Enumeration Date:
08/05/2026