Provider First Line Business Practice Location Address:
110 E BUTLER ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FORT RECOVERY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45846-0605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-375-2323
Provider Business Practice Location Address Fax Number:
419-375-5500
Provider Enumeration Date:
01/10/2007