| NPI | 1346791654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUN WHITE Manager 502-244-9859 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2016-10-21 |