Provider First Line Business Practice Location Address:
OHIO STATE UNIVERSITY
Provider Second Line Business Practice Location Address:
TWELFTH AVE, 395 W
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-366-5445
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2022