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 |