| NPI | 1083976989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY KLEIN Sole Member 606-638-0033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: KY 31770) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2012-06-15 |