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Organization

INDEPENDENT PROVIDER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LA'TASHA DENISE LEE (INDEPENDENT PROVIDER)
(979) 451-3843
Entity
Organization

Contact information

Practice address
5659 TROY VILLA BLVD, DAYTON, OH 45424-2645
(979) 451-3843
Mailing address
5659 TROY VILLA BLVD, DAYTON, OH 45424-2645
(979) 451-3843

Taxonomy

Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary

Other

Enumeration date
10/03/2014
Last updated
10/03/2014
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