Provider First Line Business Practice Location Address:
830 W HIGH ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45801-3971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-229-8928
Provider Business Practice Location Address Fax Number:
419-229-5291
Provider Enumeration Date:
11/29/2006