| NPI | 1669675740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MODISH LANE Administrator 216-591-1862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: OH 0348as) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2008-03-19 |