| NPI | 1821217308 |
|---|---|
| Doing Business As | INDEPENDENT PROVIDER |
| Entity Type | Organization |
| Authorized Contact | WENDY SUE CAPPER Independent Provider 937-324-4438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: OH SK307751) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: OH SK307751) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-08-22 |