| NPI | 1770710188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH LISZAK CEO 419-334-8943 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2011-06-23 |