Provider First Line Business Practice Location Address: 
2140 POGUE AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
CINCINNATI
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
45208-3234
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
513-682-4040
    Provider Business Practice Location Address Fax Number: 
888-810-8182
    Provider Enumeration Date: 
03/19/2012