Provider First Line Business Practice Location Address:
212 E WYANDOT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER SANDSKY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43351-1432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-294-2421
Provider Business Practice Location Address Fax Number:
419-294-2499
Provider Enumeration Date:
08/10/2006