Provider First Line Business Practice Location Address:
113 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BALTIMORE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45872-1124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-257-9070
Provider Business Practice Location Address Fax Number:
419-257-0501
Provider Enumeration Date:
10/13/2008