| NPI | 1396276432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHALILAH KRYSTAL LARUE Certfied Nurse Practitioner 614-668-2149 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: OH 10483) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2024-07-02 |