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36336 Vine St Suite 100 Willowick OH 44095-3164 | |
(216) 261-6398 | |
(216) 261-6398 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 36336 Vine St, Willowick, Ohio |
Authorized Official Name and Position | Donavon Huff (VP. OF OPERATIONS) |
Authorized Official Contact | 2162616398 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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36336 Vine Street Suite 100 Eastlake OH 44095 Ph: (216) 261-6398 | 36336 Vine St Suite 100 Willowick OH 44095-3164 Ph: (216) 261-6398 |
NPI Number | 1649672106 |
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Provider Enumeration Date | 09/16/2014 |
Last Update Date | 10/23/2014 |
Identifier | Type | State | Issuer |
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1649672106 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |