Provider First Line Business Practice Location Address: 
1900 23RD STREET
    Provider Second Line Business Practice Location Address: 
SUMMA WESTERN RESERVE HOSPITAL
    Provider Business Practice Location Address City Name: 
CUYAHOGA FALLS
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44223
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
330-971-2255
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
03/21/2013