| NPI | 1255620340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNESSA RENEE' BLACKMUN Owner 502-418-4809 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MO 2010035799) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2016-04-05 |