Provider First Line Business Practice Location Address:
3349 EXECUTIVE PKY
Provider Second Line Business Practice Location Address:
SUITE G GLENN R FAUSZ DDS INC
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43606-5305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-534-4970
Provider Business Practice Location Address Fax Number:
419-534-4970
Provider Enumeration Date:
10/18/2006