Provider First Line Business Practice Location Address:
3920 US HIGHWAY 23
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:
45662-6468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-354-2877
Provider Business Practice Location Address Fax Number:
740-355-2360
Provider Enumeration Date:
08/10/2006