| NPI | 1548083355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENESHA STONE Owner 502-708-0013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2024-11-01 |
| Last Update Date | 2024-11-01 |