Provider First Line Business Practice Location Address:
5871 MONCLOVA RD
Provider Second Line Business Practice Location Address:
DIABETES CARE CENTER @ ST. LUKE'S HOSPITAL
Provider Business Practice Location Address City Name:
MAUMEE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43537-1839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-897-8391
Provider Business Practice Location Address Fax Number:
419-887-8789
Provider Enumeration Date:
08/27/2009