| NPI | 1427494905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WASILISIN Owner 330-501-4489 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 31327) |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2013-05-10 |