Provider First Line Business Practice Location Address:
138 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEIPSIC
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45856-1427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-943-2561
Provider Business Practice Location Address Fax Number:
419-943-2559
Provider Enumeration Date:
08/10/2006