| NPI | 1689860207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA A ORTIZ ALVARADO Billing/Credentialing 330-533-3040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OH 100427) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2024-04-30 |