| NPI | 1265141097 |
|---|---|
| Doing Business As | OSU-AJ OSU MEDICAL GROUP RIVERSIDE |
| Entity Type | Organization |
| Authorized Contact | ERIC JOHN POLAK Vice President Of Admin/Finance 918-561-8422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2022-11-21 |