| NPI | 1376720623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY PETRO Ownerr/Proprietor 419-424-0100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: OH 1080) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2012-04-11 |