Provider First Line Business Practice Location Address:
136 N SANDUSKY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER SANDUSKY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43351-1254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-294-1916
Provider Business Practice Location Address Fax Number:
419-294-0087
Provider Enumeration Date:
08/23/2006