Provider First Line Business Practice Location Address:
825 E HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45505-1198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-323-0951
Provider Business Practice Location Address Fax Number:
937-933-4050
Provider Enumeration Date:
04/19/2010