Provider First Line Business Practice Location Address:
15 E. MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEIPSIC
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-384-3278
Provider Business Practice Location Address Fax Number:
419-384-3280
Provider Enumeration Date:
12/05/2010