Individual
DAEMON KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1096 E 177TH ST, CLEVELAND, OH 44119-3142
(216) 882-9770
Mailing address
1096 E 177TH ST, CLEVELAND, OH 44119-3142
(216) 882-9770
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
RU778586
OH
Other
Enumeration date
03/28/2022
Last updated
03/28/2022
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