| NPI | 1487968970 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA MARIE MODIC Owner 330-792-2577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: OH 35055600) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2010-09-07 |