Provider First Line Business Practice Location Address:
1770 SOUTH 28TH ST.
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:
43119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-537-2130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2025