| NPI | 1376253351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IESHA AUSTIN-OWENS Owner 419-486-9685 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2022-11-30 |
| Last Update Date | 2022-11-30 |