Provider First Line Business Practice Location Address:
1200 PROSPECT ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
SANDUSKY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-621-5780
Provider Business Practice Location Address Fax Number:
419-621-5791
Provider Enumeration Date:
09/09/2005