| NPI | 1275683690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY M HEIDBREDER Credentialing Coordinator 330-867-5603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251S00000X (Licence: OH 0003876) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2012-08-29 |