Provider First Line Business Practice Location Address:
830 W HIGH ST
Provider Second Line Business Practice Location Address:
STE 304
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45801-3978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-228-9098
Provider Business Practice Location Address Fax Number:
419-222-6604
Provider Enumeration Date:
06/21/2005