Provider First Line Business Practice Location Address:
4100 N HIGH ST
Provider Second Line Business Practice Location Address:
OVERBROOK CLINIC SUITE NO 201
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43214-3252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-263-2113
Provider Business Practice Location Address Fax Number:
614-263-2115
Provider Enumeration Date:
04/18/2007