Provider First Line Business Practice Location Address:
830 3RD ST, ATHLETIC CENTER ROOM 138
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-529-7760
Provider Business Practice Location Address Fax Number:
606-324-0616
Provider Enumeration Date:
10/17/2023