Provider First Line Business Practice Location Address:
10 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER SANDUSKY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43351-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-294-4916
Provider Business Practice Location Address Fax Number:
419-294-6434
Provider Enumeration Date:
09/27/2005