| NPI | 1295618445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SULLIVAN Credentialing Specialist 440-453-0754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2025-07-28 |
| Last Update Date | 2025-07-28 |