| NPI | 1598543845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARRA J WALTMIRE CEO 419-210-5251 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2023-09-18 |
| Last Update Date | 2025-03-13 |