Provider First Line Business Practice Location Address: 
624 S. HIGH ST.
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HILLSBORO
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
45133
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
937-393-3494
    Provider Business Practice Location Address Fax Number: 
937-393-6864
    Provider Enumeration Date: 
08/11/2010