Provider First Line Business Practice Location Address:
112 WEST BUTLER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT RECOVERY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45846-0672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-375-1808
Provider Business Practice Location Address Fax Number:
419-375-1709
Provider Enumeration Date:
11/08/2006