Provider First Line Business Practice Location Address:
535 IRVING SCHOTTENSTEIN DR
Provider Second Line Business Practice Location Address:
WOODY HAYES ATHLETIC CENTER
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43210-1044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-292-1165
Provider Business Practice Location Address Fax Number:
614-292-3258
Provider Enumeration Date:
01/08/2008