Provider First Line Business Practice Location Address:
1260 S DEFIANCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCHBOLD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43502-1620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
567-444-4898
Provider Business Practice Location Address Fax Number:
567-444-4899
Provider Enumeration Date:
12/29/2015