| NPI | 1295186146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN RICHARD BLACK Socila Worker 614-288-3103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA (Licence: OH S1600341) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2016-06-22 |