| NPI | 1740478767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEROME PRITCHARD STEVENSON President 937-268-2663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI L90474) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2007-10-04 |