| NPI | 1407993074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA ROBACK Office Manager 606-679-7317 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2011-06-21 |