Provider First Line Business Practice Location Address:
1021 COUNTRY CLUB RD
Provider Second Line Business Practice Location Address:
SUITE A PEDIATRIC ASSOCIATES INC
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-501-7337
Provider Business Practice Location Address Fax Number:
614-434-2726
Provider Enumeration Date:
07/09/2008