| NPI | 1093084584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY L GREEN Office Manager 937-275-8559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 34-002567) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-056515-C) |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2011-12-29 |