| NPI | 1366294456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERIAH WALTERS Credentialing Specialist 740-371-7007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2024-04-03 |
| Last Update Date | 2024-04-03 |