Provider First Line Business Practice Location Address:
1307 E. HIGH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45505-4245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-525-0809
Provider Business Practice Location Address Fax Number:
937-525-9027
Provider Enumeration Date:
09/19/2012