Individual
JOVONTAE CASEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1211 INNISFALLEN AVE, SPRINGFIELD, OH 45506-1962
(937) 925-1412
Mailing address
1211 INNISFALLEN AVE, SPRINGFIELD, OH 45506-1962
(937) 925-1412
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
TG659863
OH
Other
Enumeration date
05/03/2022
Last updated
05/03/2022
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