| NPI | 1053504423 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATY A TRACY Office Manager 937-643-9939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2022-07-21 |