Provider First Line Business Practice Location Address: 
11100 EUCLID AVE
    Provider Second Line Business Practice Location Address: 
UH CASE MEDICAL CENTER- FAMILY MEDICINE DEPT
    Provider Business Practice Location Address City Name: 
CLEVELAND, OH
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44106-5036
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
347-267-8225
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
04/27/2011