| NPI | 1679341671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SULLIVAN Credentialing Specialist 440-453-0754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2023-12-19 |
| Last Update Date | 2024-07-02 |