Provider First Line Business Practice Location Address:
600 LAFAYETTE 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:
43502-1656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-446-2728
Provider Business Practice Location Address Fax Number:
419-445-8536
Provider Enumeration Date:
02/10/2009