| NPI | 1831586577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY MARIE BARNES CEO/ Management 800-722-7164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OH 2307679) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2015-04-21 |