Provider First Line Business Practice Location Address:
608 N DEFIANCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCHBOLD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43502-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-717-0437
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/26/2026