Provider First Line Business Practice Location Address:
142 N GAMBLE ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44875-2114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-342-6366
Provider Business Practice Location Address Fax Number:
419-342-4108
Provider Enumeration Date:
06/23/2006