| NPI | 1255881033 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY FAIRCHILD Billing Manager 606-886-0224 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: KY 02805) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 02805) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2016-10-05 |