| NPI | 1366227555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAEDAWNUA JADE STRUNK Credentialing 606-435-7642 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2023-08-28 |