| NPI | 1659590164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LT NICHOLS CEO 888-627-7586 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OH 30172139500) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-08-22 |