Provider First Line Business Practice Location Address:
6270 N. RIDGE ROAD
Provider Second Line Business Practice Location Address:
LAKE HEALTH PHYSICIAN GROUP MADISON PEDIATRICS
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-428-6225
Provider Business Practice Location Address Fax Number:
440-428-8226
Provider Enumeration Date:
07/24/2007