Provider First Line Business Practice Location Address:
635 CLINTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEFIANCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43512-2610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-438-8186
Provider Business Practice Location Address Fax Number:
419-785-2262
Provider Enumeration Date:
10/06/2026