Provider First Line Business Practice Location Address:
92 N 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 22
Provider Business Practice Location Address City Name:
MARTINS FERRY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43935-1691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-633-6332
Provider Business Practice Location Address Fax Number:
740-633-4446
Provider Enumeration Date:
07/23/2007