Provider First Line Business Practice Location Address:
152 S FULTON ST
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
WAUSEON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-337-9255
Provider Business Practice Location Address Fax Number:
419-337-9285
Provider Enumeration Date:
08/31/2006