Individual
STEVENSON BLACK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
667 E 109TH ST, CLEVELAND, OH 44108-2767
(216) 326-7889
Mailing address
667 E 109TH ST, CLEVELAND, OH 44108-2767
(216) 326-7889
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
RU776031
OH
Other
Enumeration date
04/06/2023
Last updated
04/06/2023
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