Provider First Line Business Practice Location Address:
825 W MARKET ST
Provider Second Line Business Practice Location Address:
SUITE204
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45805-2799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-224-6100
Provider Business Practice Location Address Fax Number:
419-228-6274
Provider Enumeration Date:
07/15/2005