Provider First Line Business Practice Location Address:
1302 1/2 4TH ST REAR
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:
45662-4611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-961-7638
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2024