Provider First Line Business Practice Location Address:
627 EDWIN C. MOSES BLVD.
Provider Second Line Business Practice Location Address:
WRIGHT STATE UNIVERSITY DEPARTMENT OF PSYCHIATRY
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45417-1461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-223-8840
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2013