Provider First Line Business Practice Location Address:
1302 DEFIANCE ST
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:
45895-1081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-738-5958
Provider Business Practice Location Address Fax Number:
419-738-3019
Provider Enumeration Date:
08/29/2005