Registry details
Type
Individual
Primary specialty
Physician Assistant, Medical
Enumerated
Feb 5, 2010
License(s)
50.002902 (OH), 50.002902RX (OH)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 474 N YELLOW SPRINGS ST | Springfield, OH 45504-2463 | 937-399-9500 |
| MAILING | PO BOX 635668 | Cincinnati, OH 45263-5668 | 937-439-3600 |
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.