| NPI | 1174156905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL COPELAND PALMER Managing Member 330-415-4473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2020-02-20 |
| Last Update Date | 2020-02-20 |