| NPI | 1427517887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUANITA MCDONNELL Secretary 330-510-1890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2019-05-23 |