Provider First Line Business Practice Location Address:
743 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:
740-353-1412
Provider Business Practice Location Address Fax Number:
740-353-1666
Provider Enumeration Date:
06/10/2006