Provider First Line Business Practice Location Address:
2330 E HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45505-1371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-324-3937
Provider Business Practice Location Address Fax Number:
937-324-8943
Provider Enumeration Date:
04/10/2007