| NPI | 1760470942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID P KELLY Administrator 937-567-5984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: OH 0568AS) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2009-06-11 |