| NPI | 1326024936 |
|---|---|
| Doing Business As | STACEY ROYAL |
| Entity Type | Organization |
| Authorized Contact | STACEY Y ROYAL Owner 419-819-0488 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD434643) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: MI 4301073222) |
| 261QP2300X Clinic/Center, Primary Care (Licence: OH 35079907R) | |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2009-07-20 |