| NPI | 1023219425 |
|---|---|
| Doing Business As | DBA JACKSON UROLOGY |
| Entity Type | Organization |
| Authorized Contact | LORETTA L CAMPBELL Clinic COO Rdinator 606-693-0531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: KY 25492) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2020-08-22 |