Provider First Line Business Practice Location Address: 
CLEVELAND CLINIC 9500 EUCLID AVE
    Provider Second Line Business Practice Location Address: 
J4-133
    Provider Business Practice Location Address City Name: 
CLEVELAND
    Provider Business Practice Location Address State Name: 
OH
    Provider Business Practice Location Address Postal Code: 
44195-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
216-445-6816
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/03/2009