| NPI | 1194917062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNY VAUGHN Office Manager 513-984-5552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OH 35041085L) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2007-08-15 |