Provider First Line Business Practice Location Address:
1821 E HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45505-1225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-323-7340
Provider Business Practice Location Address Fax Number:
937-323-3363
Provider Enumeration Date:
04/03/2007