Provider First Line Business Practice Location Address:
520 W LINCOLN AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ADA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45810-9466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-634-4085
Provider Business Practice Location Address Fax Number:
419-634-4022
Provider Enumeration Date:
02/15/2006