| NPI | 1992927206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARLA JEAN GRISWOLD Health Care Provider 440-466-3755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |