Individual
BRELAND JUWAN COSPY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
317 STUBBS DR, TROTWOOD, OH 45426-3160
(937) 815-4673
Mailing address
317 STUBBS DR, TROTWOOD, OH 45426-3160
(937) 815-4673
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
UH298850
OH
Other
Enumeration date
12/14/2021
Last updated
12/14/2021
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