Provider First Line Business Practice Location Address:
900 SCIOTO ST
Provider Second Line Business Practice Location Address:
MERCY MEDICAL BUILDING SUITE 1
Provider Business Practice Location Address City Name:
URBANA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43078-2251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-484-6784
Provider Business Practice Location Address Fax Number:
937-484-6531
Provider Enumeration Date:
05/17/2007