Provider First Line Business Practice Location Address:
2801 BAY PARK DR
Provider Second Line Business Practice Location Address:
MEDICAL STAFF OFFICE
Provider Business Practice Location Address City Name:
OREGON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43616-4920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-690-8877
Provider Business Practice Location Address Fax Number:
419-697-4334
Provider Enumeration Date:
10/06/2005