| NPI | 1235585159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRETCHEN TYSON Credentialing Specialist 740-450-6147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP0904X Clinic/Center, Public Health, Federal (Licence: OH COA19004-NP) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2016-05-16 |