Provider First Line Business Practice Location Address:
134 W SOUTH BOUNDARY ST
Provider Second Line Business Practice Location Address:
SUITE MM
Provider Business Practice Location Address City Name:
PERRYSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43551-1763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-873-0891
Provider Business Practice Location Address Fax Number:
419-873-0892
Provider Enumeration Date:
01/02/2007