| NPI | 1760974349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH ANTHONY VUKASINOVICH Business Manager/Clinical Manager 937-672-1424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: OH 14345) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2023-12-20 |