Organization
INDEPENDENT PROVIDER
Active
Other names
Independent Provider
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TASSHIA RENEE LEE (INDEPENDENT PROVIDER)
(614) 571-5191
Entity
Organization
Contact information
Practice address
3664 LARKWELL WAY, COLUMBUS, OH 43232-3611
(614) 571-5191
Mailing address
3664 LARKWELL WAY, COLUMBUS, OH 43232
(614) 571-5191
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
2870880
OH
Other
Enumeration date
06/24/2014
Last updated
06/24/2014
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