Provider First Line Business Practice Location Address:
901 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LEIPSIC
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45856-9326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-943-2130
Provider Business Practice Location Address Fax Number:
419-943-2146
Provider Enumeration Date:
11/21/2005