Provider First Line Business Practice Location Address:
44 CLAY HIGH 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:
45662-8817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-354-6645
Provider Business Practice Location Address Fax Number:
740-354-5746
Provider Enumeration Date:
02/10/2009