Provider First Line Business Practice Location Address:
1220 E ELM ST
Provider Second Line Business Practice Location Address:
MEDICAL PROFESSIONAL BUILDING #1, SUITE 140
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45804-2850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-695-8010
Provider Business Practice Location Address Fax Number:
419-695-0565
Provider Enumeration Date:
04/26/2006