| NPI | 1417032764 |
|---|---|
| Doing Business As | SOUTH TOWN FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | KENNETH PRUNIER President/CEO 937-208-8213 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2013-11-06 |