| NPI | 1457228603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXANN CORDIAL Credentialing Manager 606-886-8572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2025-10-22 |
| Last Update Date | 2025-10-22 |