| NPI | 1063810091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER SISCO Managing Member 606-653-1505 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: KY 740318) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: KY 740318) |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: KY 740318) | |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2022-09-09 |