Provider First Line Business Practice Location Address: 
195 HEALTH SERVICES BUILDING
    Provider Second Line Business Practice Location Address: 
MIAMI UNIVERSITY
    Provider Business Practice Location Address City Name: 
OXFORD
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
45056
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
513-529-4634
    Provider Business Practice Location Address Fax Number: 
513-529-2975
    Provider Enumeration Date: 
05/14/2007