| NPI | 1306127303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN SUE HARRIS Authorized Agent 270-283-4638 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: KY 03286) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: KY 03286) |
| 261QP2300X Clinic/Center, Primary Care (Licence: KY 03286) | |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2013-01-30 |