Provider First Line Business Practice Location Address: 
9500 EUCLID AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
CLEVELAND
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44195-1000
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
216-445-6900
    Provider Business Practice Location Address Fax Number: 
216-636-3074
    Provider Enumeration Date: 
06/26/2006