Organization
SOCIASO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CORNELL D TALLEY (CEO)
(614) 584-4512
Entity
Organization
Contact information
Practice address
195 N HARDING RD, COLUMBUS, OH 43209-1525
(614) 584-4512
Mailing address
195 N HARDING RD, COLUMBUS, OH 43209-1525
(614) 584-4512
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
OH
Other
Enumeration date
02/08/2016
Last updated
02/08/2016
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