| NPI | 1760025100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA ANN HACKER Fiscal Coordinator 419-626-5623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2023-07-26 |