Provider First Line Business Practice Location Address:
1319 SPRING STREET
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:
740-354-6619
Provider Business Practice Location Address Fax Number:
740-354-5710
Provider Enumeration Date:
07/07/2005