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 |