| NPI | 1023423357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY DIANA WILSON Office Manager 270-782-0434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: KY SA272) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2014-06-25 |