Provider First Line Business Practice Location Address:
1835 E HIGH ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45505-1276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-322-8977
Provider Business Practice Location Address Fax Number:
937-322-5837
Provider Enumeration Date:
11/14/2008