Provider First Line Business Practice Location Address:
2351 EAST 22ND STREET
Provider Second Line Business Practice Location Address:
ST VINCENT CHARITY MEDICAL CTR
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44115-2737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-363-2538
Provider Business Practice Location Address Fax Number:
216-694-4625
Provider Enumeration Date:
06/30/2008