| NPI | 1366176919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA F CAUDILL Administrator 606-373-4887 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2022-07-11 |
| Last Update Date | 2022-09-27 |