Provider First Line Business Practice Location Address: 
2213 CHERRY STREET
    Provider Second Line Business Practice Location Address: 
MERCY ST. VINCENT MEDICAL CENTER
    Provider Business Practice Location Address City Name: 
TOLEDO
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
43608
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
419-251-3232
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/08/2011