| NPI | 1992127500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD GRONBECK Owner 937-767-1088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: OH 35.120593) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2021-02-02 |