| NPI | 1932513694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA YVETTE BLAKE Stna 216-937-9110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OH 401616630214) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2014-06-19 |