| NPI | 1942659537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEHDRA MONIQUE MCCOLLUM Independent Provider 216-396-8203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2016-06-06 |