| NPI | 1942407879 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | ANDRE DE LEON Clinical Instructor House Staff 614-293-2655  | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care | 
| Enumeration Date | 2007-07-03 | 
| Last Update Date | 2020-08-22 |