| NPI | 1033455209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY CLOUD CEO 614-274-1455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2012-12-17 |
| Last Update Date | 2022-03-11 |