| NPI | 1114426863 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXANN CORDIAL Credentialing 606-886-8572 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: KY 700264) |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2024-08-15 |