| NPI | 1073997714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NILES CHARLET Owner 502-386-6380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: KY MFTMFA00220821) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2015-07-13 |