Provider First Line Business Practice Location Address:
970 W SOUTH BOUNDARY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERRYSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43551-5232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-872-7336
Provider Business Practice Location Address Fax Number:
419-872-7460
Provider Enumeration Date:
07/28/2005