| NPI | 1114107331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAA NADOUR Physician 419-215-4109 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI 4301088893) |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2007-11-05 |