| NPI | 1548592017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER HAHN Office Manager 419-625-0925 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OH 46193) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: OH 46192) |
| Enumeration Date | 2010-02-08 |
| Last Update Date | 2012-08-17 |