Provider First Line Business Practice Location Address:
122 N 5TH ST
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:
43351-1211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-764-0256
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2025