Provider First Line Business Practice Location Address:
9030 MONTGOMERY RD
Provider Second Line Business Practice Location Address:
C/O SOMA WELLNESS
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45242-7741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-505-6800
Provider Business Practice Location Address Fax Number:
513-297-9429
Provider Enumeration Date:
07/10/2012