Organization
JLA SENIOR FOOTCARE MO LLC
Active
Organization
JLA SENIOR FOOTCARE MO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY INNOCENZI (OWNER)
(330) 702-0978
Entity
Organization
Contact information
Practice address
640 W 67TH TER, KANSAS CITY, MO 64113-1945
(816) 516-7453
Mailing address
4870 S ASPEN CT, CANFIELD, OH 44406-8469
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
1200367
KS
Other
Enumeration date
09/07/2010
Last updated
09/07/2010
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