| NPI | 1114192895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA DERR Provider Enrollment Specialist 270-744-9600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 37523) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2008-04-24 |