| NPI | 1912705930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SULLIVAN Credentialing Specialist 440-453-0754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2025-03-05 |
| Last Update Date | 2025-03-05 |