Provider First Line Business Practice Location Address:
1519 N MAIN ST
Provider Second Line Business Practice Location Address:
STE 6
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-222-4557
Provider Business Practice Location Address Fax Number:
419-224-8608
Provider Enumeration Date:
11/22/2006