Provider First Line Business Practice Location Address: 
2142 N COVE BLVD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
TOLEDO
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
43606-3895
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
419-291-4000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/19/2005