| NPI | 1083047054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE ALLISON WILSON Cnp 1216-844-2798 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: OH RN279047) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2013-08-14 |