| NPI | 1538250832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUS A BYNUM President 502-868-0008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2008-05-14 |