| NPI | 1609329796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW ALLEN MINNICH Director, Provider Relations 937-436-4536 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2016-07-26 |