Provider First Line Business Practice Location Address:
1247 IDA STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45202-1525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-241-8919
Provider Business Practice Location Address Fax Number:
513-241-8918
Provider Enumeration Date:
09/22/2006