Provider First Line Business Practice Location Address:
1430 SOUTH HIGH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-443-0583
Provider Business Practice Location Address Fax Number:
614-443-2528
Provider Enumeration Date:
07/28/2006