| NPI | 1275409377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE T DOUGLAS COO 419-720-7883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2025-10-15 |
| Last Update Date | 2025-10-15 |