Provider First Line Business Practice Location Address:
121 W SOPHIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAUMEE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43537-2164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-893-4541
Provider Business Practice Location Address Fax Number:
419-893-7199
Provider Enumeration Date:
03/08/2007