Provider First Line Business Practice Location Address: 
3000 ARLINGTON AVE
    Provider Second Line Business Practice Location Address: 
MS 1050, GRADUATE MEDICAL EDUCATION
    Provider Business Practice Location Address City Name: 
TOLEDO
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
43614-2595
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
816-724-1908
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/18/2014