| NPI | 1922337666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEROME A DENMARK Director 937-610-2703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OH PN088678) |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2009-12-08 |