Provider First Line Business Practice Location Address:
1300 E 2ND ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DEFIANCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43512-2482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-784-3818
Provider Business Practice Location Address Fax Number:
419-782-4979
Provider Enumeration Date:
10/24/2005