| NPI | 1699907873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWAYNE ALLEN BODRICK Owner 614-579-5382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OH 2951024) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2011-02-01 |