Provider First Line Business Practice Location Address:
4611 N SUMMIT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43611-2812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-729-3972
Provider Business Practice Location Address Fax Number:
419-729-3938
Provider Enumeration Date:
05/24/2005