Provider First Line Business Practice Location Address:
741 2ND 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:
45662-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-354-5622
Provider Business Practice Location Address Fax Number:
740-353-1275
Provider Enumeration Date:
10/07/2006