| NPI | 1255689741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA RAE MYERSON Clinic Manager 513-458-8845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: OH 160163WA2000x) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2012-08-15 |