Individual
TYETTA PATRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
730 ALMOND AVE, DAYTON, OH 45417-1207
(937) 540-5818
Mailing address
PO BOX 49343, DAYTON, OH 45449-0343
(937) 540-5818
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
07/14/2021
Last updated
07/14/2021
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