Provider First Line Business Practice Location Address:
1725 LOGAN 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:
45662-3667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-442-0380
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/26/2024