| NPI | 1295908101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDGAR ALLEN MENDOZA Owner 606-693-4800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: KY 33465) |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2014-07-10 |