Provider First Line Business Practice Location Address:
620 W LEGGETT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUSEON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43567-1348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-335-7272
Provider Business Practice Location Address Fax Number:
419-335-5564
Provider Enumeration Date:
01/29/2007