| NPI | 1447764352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN STOVER Executive Director 502-554-5601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2024-04-12 |