Provider First Line Business Practice Location Address:
801 MEDICAL DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45804-4030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-222-6622
Provider Business Practice Location Address Fax Number:
419-224-0015
Provider Enumeration Date:
10/14/2015