| NPI | 1093995664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN ELAINE WALLRT Lpn 740-858-2828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OH PN 113668) |
| Enumeration Date | 2007-11-12 |
| Last Update Date | 2007-11-12 |