Provider First Line Business Practice Location Address:
2501 E. HIGH STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-328-8700
Provider Business Practice Location Address Fax Number:
937-328-8719
Provider Enumeration Date:
05/16/2006