| NPI | 1518712538 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FONDA DICKERSON Owner 502-384-1378 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0800X Clinic/Center, Recovery Care |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-04-22 |