| NPI | 1508938572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY MARVIN NELSON Owner 270-443-0708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: KY 02797) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2010-11-05 |