Provider First Line Business Practice Location Address:
480 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
DODD HALL
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43210-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-367-1752
Provider Business Practice Location Address Fax Number:
614-293-9179
Provider Enumeration Date:
08/10/2010