Provider First Line Business Practice Location Address:
1010 24TH 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:
45662-2822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-354-6631
Provider Business Practice Location Address Fax Number:
740-355-8513
Provider Enumeration Date:
07/25/2006