Provider First Line Business Practice Location Address:
2015 S DEFIANCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCHBOLD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43502-9111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-445-0052
Provider Business Practice Location Address Fax Number:
419-445-0053
Provider Enumeration Date:
05/17/2006