Provider First Line Business Practice Location Address: 
2123 AUBURN AVE STE 204
    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: 
45219-2906
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
513-251-9900
    Provider Business Practice Location Address Fax Number: 
513-244-4130
    Provider Enumeration Date: 
06/06/2011