| NPI | 1063615268 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID S DECKER Owner 502-499-0588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: KY 23642) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2020-08-22 |