Provider First Line Business Practice Location Address:
107 HOUPT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER SANDUSKY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43351-9201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-294-5757
Provider Business Practice Location Address Fax Number:
419-209-0623
Provider Enumeration Date:
11/17/2005