Provider First Line Business Practice Location Address:
217 N COUNTYLINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOSTORIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-435-1894
Provider Business Practice Location Address Fax Number:
419-435-4244
Provider Enumeration Date:
12/11/2006