Provider First Line Business Practice Location Address:
131 1/2 PLUM ST UPPR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHILLICOTHEE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45601-2326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-656-8830
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2024