Provider First Line Business Practice Location Address:
1343 NORTH FOUNTAIN BLVD.
Provider Second Line Business Practice Location Address:
SPRINGFIELD REGIONAL MEDICAL CENTER, NUTRITION SERVICES
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45504-1499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-390-5510
Provider Business Practice Location Address Fax Number:
937-390-5358
Provider Enumeration Date:
08/25/2009