Provider First Line Business Practice Location Address:
250 BILL EDWARDS DR
Provider Second Line Business Practice Location Address:
WITTENBERG UNIVERSITY ATHLETICS
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45504-2130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-582-7145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2008