| NPI | 1255514873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK G SIEBENALER Owner 419-691-0636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: OH 350535801S) |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2012-02-22 |