| NPI | 1174108385 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES MICA COO 440-895-5057 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2021-03-10 |