| NPI | 1023423571 |
|---|---|
| Other Name | INDEPENDENT PROVIDER |
| Entity Type | Organization |
| Authorized Contact | TASSHIA RENEE LEE Independent Provider 614-571-5191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OH 2870880) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2014-06-24 |