Provider First Line Business Practice Location Address: 
8991 OHIO RIVER RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
WHEELERSBURG
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
45694-1923
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
740-981-3334
    Provider Business Practice Location Address Fax Number: 
740-981-3340
    Provider Enumeration Date: 
04/15/2013