| NPI | 1780179796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA M NETHERLY Owner 513-549-2710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: OH 201806900600) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2018-06-22 |