| NPI | 1255622544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER BENGE Owner 270-598-4910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 00337) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: KY 00337) |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2016-03-22 |