| NPI | 1447449350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY BROOKE GREAM Office Manager 270-443-0010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: KY 38909) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2025-08-13 |