Provider First Line Business Practice Location Address:
1100 DEFIANCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAPAKONETA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45895-1022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-996-5122
Provider Business Practice Location Address Fax Number:
419-996-5123
Provider Enumeration Date:
07/28/2006