| NPI | 1124072004 |
|---|---|
| Doing Business As | FAIRFIELD ROAD PHYSICIAN OFFICE |
| Entity Type | Organization |
| Authorized Contact | KENNETH PRUNIER CEO/President 937-208-8213 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2013-11-06 |