Provider First Line Business Practice Location Address: 
1800 ZOLLINGER RD FL 4
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
COLUMBUS
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
43221-2800
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
614-293-4643
    Provider Business Practice Location Address Fax Number: 
614-293-3332
    Provider Enumeration Date: 
07/06/2011