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| Type | Address | [sources] | |||
|---|---|---|---|---|---|
| Country | United States | [sources] | |||
| City | Lakewood | [sources] | |||
| Full address | 12700 Lake Ave., Apt. 714, Lakewood, OH 44107 | [sources] | |||
| Postal code | 44107 | [sources] | |||
| State | OH | [sources] | |||
| Street address | 12700 Lake Ave., Apt. 714 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers excluded or suspended from Ohio's Medicaid program.
United States · ODM
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