| NPI | 1336111376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY LOUISE RALSTON Practice Manager 502-368-9590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: KY 22609) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2007-10-09 |