| NPI | 1265720221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALSENY BALDE Manager 502-572-9990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NY 250592) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2011-07-12 |