| NPI | 1164841912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH SKELLINGER Practice Manager 937-771-6496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: OH 35.120593) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2021-02-02 |