| NPI | 1043766801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS WILLIAM FOWLES Owner 859-358-3069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: KY 38140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 38140) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2026-07-23 |