| NPI | 1194161984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL S RANALLO Secretary 270-417-4813 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health (Licence: KY 900257) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2022-12-07 |