Organization
JLA SENIOR FOOTCARE CO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY INNOCENZI (OWNER)
(330) 702-0978
Entity
Organization
Contact information
Practice address
2101 S GARFIELD AVE, LOVELAND, CO 80537-7377
(330) 702-0978
Mailing address
4870 S ASPEN CT, CANFIELD, OH 44406-8469
(330) 702-0978
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
700
CO
Other
Enumeration date
09/02/2010
Last updated
09/02/2010
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