| NPI | 1053024034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER NICOLE JORDAN Interventionist 606-595-1500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Enumeration Date | 2023-01-04 |
| Last Update Date | 2023-01-04 |