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 |