| NPI | 1093488926 |
|---|---|
| Doing Business As | 3 FORM - WEST VALLEY CITY |
| Entity Type | Organization |
| Authorized Contact | JON LEIZMAN President 216-479-9063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2022-08-24 |