Registry details
Type
Individual
Primary specialty
—
Enumerated
Jun 6, 2006
License(s)
A78127 (CA), 35.096133 (OH), 35.096133 (OH)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 4000 MIAMISBURG CENTERVILLE RD | Miamisburg, OH 45342-7615 | 937-384-4511 |
| MAILING | 4000 MIAMISBURG CENTERVILLE RD PHYSICIAN OFFICE BUILDING, SUITE 420 | Miamisburg, OH 45342-7615 | 937-384-4511 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.