Provider First Line Business Practice Location Address:
395 W. 12TH AVE THE OHIO STATE UNIVERSITY WEXNER MEDICA
Provider Second Line Business Practice Location Address:
SUITE 346A
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-293-9812
Provider Business Practice Location Address Fax Number:
614-293-9789
Provider Enumeration Date:
04/19/2024