Individual
ANTONIO WESLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5162 BROADWAY AVE, CLEVELAND, OH 44127-1571
(216) 938-6829
Mailing address
5162 BROADWAY AVE, CLEVELAND, OH 44127-1571
(216) 938-6829
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CDCA.164600
OH
Other
Enumeration date
12/21/2017
Last updated
12/21/2017
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