Provider First Line Business Practice Location Address:
OHIO STATE DENTAL FACILITY PRACTICE
Provider Second Line Business Practice Location Address:
305 W. 12TH AVE., ROOM 2301
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43210-1267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-292-1472
Provider Business Practice Location Address Fax Number:
614-688-3553
Provider Enumeration Date:
08/31/2011