| NPI | 1174631725 |
|---|---|
| Doing Business As | WALDEN PONDS PRIMARY CARE |
| Entity Type | Organization |
| Authorized Contact | KENNETH J PRUNIER President/CEO 937-208-8213 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2013-11-06 |