| NPI | 1194901066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLIE WUKOVICH Practice Manager 330-558-0405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34007490) |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2013-07-09 |