Provider First Line Business Practice Location Address:
109 HOUPT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER SANDUSKY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43351-9201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
567-245-5888
Provider Business Practice Location Address Fax Number:
419-427-2864
Provider Enumeration Date:
09/08/2023