Provider First Line Business Practice Location Address:
139 W INDIANA AVE
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
PERRYSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43551-1583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-874-4463
Provider Business Practice Location Address Fax Number:
419-874-5244
Provider Enumeration Date:
08/12/2005