Provider First Line Business Practice Location Address:
13816 COUNTY HIGHWAY 47
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:
43351-9369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
567-301-6769
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2026