| NPI | 1376713925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE JOAN MODIE Medical Biller 330-225-7733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2011-11-02 |