Individual
KELLI BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
724 QUILLIAMS RD, CLEVELAND HEIGHTS, OH 44121-1956
(216) 512-5929
Mailing address
724 QUILLIAMS RD, CLEVELAND HEIGHTS, OH 44121-1956
(216) 512-5929
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
10/19/2021
Last updated
12/07/2023
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