| NPI | 1104052844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN ELAINE BOEHM Sole Proprietor 419-724-6888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: OH 35056573B) |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2011-12-23 |