| NPI | 1104122340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH BREANNA HANSON Lpn 330-780-1270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: OH PN 109895) |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2011-02-07 |