| NPI | 1124477559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA ANN RABENECK Manager 502-225-4260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: KY R5453) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2016-06-07 |