Provider First Line Business Practice Location Address:
400 E BUTLER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT RECOVERY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-375-4139
Provider Business Practice Location Address Fax Number:
419-375-1058
Provider Enumeration Date:
03/30/2010