Provider First Line Business Practice Location Address: 
21 GARFIELD PLACE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
CINCINNATI
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
45202
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
513-721-0277
    Provider Business Practice Location Address Fax Number: 
513-721-2824
    Provider Enumeration Date: 
03/23/2006