Provider First Line Business Practice Location Address: 
7341 CENTER ST
    Provider Second Line Business Practice Location Address: 
MANE STREET SALON
    Provider Business Practice Location Address City Name: 
MENTOR
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44060-5801
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
440-255-7479
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/04/2006