| NPI | 1659544989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLYN SUE SCROGGINS Medical Assistant 330-648-9060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: OH OH35079345S) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2008-04-08 |