Provider First Line Business Practice Location Address:
143 EAST FRONT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43450-0897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-287-3238
Provider Business Practice Location Address Fax Number:
419-287-2008
Provider Enumeration Date:
10/02/2006