Provider First Line Business Practice Location Address:
1130 CONGRESS AVENUE
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:
45246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-772-2442
Provider Business Practice Location Address Fax Number:
513-772-2844
Provider Enumeration Date:
12/22/2005