Provider First Line Business Practice Location Address:
1834 E HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45505-1253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-324-2442
Provider Business Practice Location Address Fax Number:
937-324-5470
Provider Enumeration Date:
10/25/2006