Provider First Line Business Practice Location Address:
1203 UPTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43607-3733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
567-440-8222
Provider Business Practice Location Address Fax Number:
567-440-8222
Provider Enumeration Date:
03/21/2026