Provider First Line Business Practice Location Address:
1500 N CLINTON ST
Provider Second Line Business Practice Location Address:
NORTHTOWN MALL
Provider Business Practice Location Address City Name:
DEFIANCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43512-8886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-782-2122
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2006