Provider First Line Business Practice Location Address:
770 WEST HIGH STREET
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45801-5901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-228-8950
Provider Business Practice Location Address Fax Number:
419-224-7904
Provider Enumeration Date:
12/19/2005