Provider First Line Business Practice Location Address:
107 N CANAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPENCERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45887-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-647-4188
Provider Business Practice Location Address Fax Number:
419-647-4421
Provider Enumeration Date:
03/12/2007