| NPI | 1386028330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD HAYES Credentialing Specialist 260-426-5431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA (Licence: OH 03233198) |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2015-07-18 |