| NPI | 1013670173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH HARTOG Owner 502-771-5432 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2021-10-15 |
| Last Update Date | 2022-07-21 |