FOUNTAIN ANTI-AGING

LAKEWOOD, OH
NPI1154834562
Doing Business AsXRMD
Entity TypeOrganization
Authorized ContactGEORGE WILLIAM ROZAKIS
Chairman
216-233-8503
Organization Subpart ?No
Primary Taxonomy207W00000X Ophthalmology
(Licence: NY  243058-1)
Additional Taxonomies207W00000X Ophthalmology
(Licence: CA  G142755)
207W00000X Ophthalmology
(Licence: CT  56673)
207W00000X Ophthalmology
(Licence: PA  MD459908)
Enumeration Date2017-11-07
Last Update Date2018-03-17
Business Address
FOUNTAIN ANTI-AGING
892 BEACH RD
LAKEWOOD, OH 44107-1018
Phone number: 216-233-8503
Mailing Address
FOUNTAIN ANTI-AGING
892 BEACH RD
LAKEWOOD, OH 44107-1018
Phone number: 216-233-8503