Provider First Line Business Practice Location Address:
213 E FRONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43450-7036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-287-3287
Provider Business Practice Location Address Fax Number:
419-287-3287
Provider Enumeration Date:
10/31/2006