| NPI | 1134829815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN SMITH Manager 502-244-9859 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2024-02-08 |