Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Jul 8, 2013
License(s)
A136805 (CA), 275039 (MA), 35.152317 (OH), 35.152317 (OH)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 2145 N FAIRFILED RD STE 100 | Beavercreek, OH 45431-2783 | 937-558-3900 |
| MAILING | 2145 N FAIRFIELD RD STE 100 | Beavercreek, OH 45431-2783 |
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.