Provider First Line Business Practice Location Address:
775 E JOHNSTOWN RD
Provider Second Line Business Practice Location Address:
C/O SUNRISE OF GAHANNA
Provider Business Practice Location Address City Name:
GAHANNA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43230-2115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-532-5199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2005