Provider First Line Business Practice Location Address:
1835 OAKLAND AVENUE
Provider Second Line Business Practice Location Address:
MERCY MEDICAL PLAZA BLDG A
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:
740-354-3500
Provider Business Practice Location Address Fax Number:
740-353-0818
Provider Enumeration Date:
08/18/2006