Provider First Line Business Practice Location Address:
228 UPPER RIVER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALLIPOLIS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-446-3836
Provider Business Practice Location Address Fax Number:
740-446-3790
Provider Enumeration Date:
09/22/2006