| NPI | 1215255286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA ERIN YOUNG Owner, Operator 419-443-0710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: OH 2823) |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2013-11-04 |