| NPI | 1407357742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KETURA JACKSON Ap RN Cnp 216-855-7775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: OH 366986) |
| 261Q00000X | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2018-02-22 |
| Last Update Date | 2018-02-22 |