Provider First Line Business Practice Location Address:
1835 NEIL AVE
Provider Second Line Business Practice Location Address:
145 PSYCHOLOGY BUILDING
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43210-1351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-688-3061
Provider Business Practice Location Address Fax Number:
614-688-8261
Provider Enumeration Date:
03/02/2007