| NPI | 1508645201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NASIRA MAH-JABEEN Credentialing Agent 502-579-0170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2023-09-22 |
| Last Update Date | 2023-09-22 |