Provider First Line Business Practice Location Address:
1045 DEARBAUGH AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
WAPAKONETA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45895-9245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-738-3422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2014