Provider First Line Business Practice Location Address:
104 NORTH MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BALTIMORE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-247-3661
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2006