Provider First Line Business Practice Location Address: 
2000 BRITTAIN RD
    Provider Second Line Business Practice Location Address: 
91 CHAPEL HILL MALL AMERICAN DENTAL CENTERS
    Provider Business Practice Location Address City Name: 
AKRON
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44310
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
330-630-9222
    Provider Business Practice Location Address Fax Number: 
330-630-2339
    Provider Enumeration Date: 
10/25/2006