| NPI | 1134455827 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NETTIE L PUTNAM Administrator/Credentialing 937-222-5496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OH 0675) |
| Enumeration Date | 2009-10-30 |
| Last Update Date | 2011-09-08 |