| NPI | 1821053042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN VEGA Executive Director 330-424-1468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: OH 1052, 0293) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2018-10-09 |