| NPI | 1518389113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY M GROLL Medical Director 937-395-8444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: MI 35.084514) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2014-01-16 |