Provider First Line Business Practice Location Address:
601 8TH 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:
45662-3928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-353-5626
Provider Business Practice Location Address Fax Number:
740-353-4321
Provider Enumeration Date:
03/20/2007