| NPI | 1649559964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN L FREDERICKS Chief Operating Officer 330-996-8603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2012-07-05 |