| NPI | 1528221157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINIQUE LEONETTA GREEN Physician 937-572-7252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35074642) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2008-07-03 |