Provider First Line Business Practice Location Address:
813 DEFIANCE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAPAKONETA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-738-3410
Provider Business Practice Location Address Fax Number:
419-738-7818
Provider Enumeration Date:
12/19/2006