| NPI | 1053646745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA JEAN HAZELTINE Incorporator 606-886-3077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: KY 25775) |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2009-10-13 |