| NPI | 1265606222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA MIX Credentialing Coordinator 270-234-1438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: KY R2738) |
| Enumeration Date | 2008-04-21 |
| Last Update Date | 2008-04-21 |