| NPI | 1861054447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY JO STONE KLINE Rcm 419-720-7883 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2019-07-03 |