| NPI | 1548892730 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW CHANDLER Practice Manager 502-276-4706 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2020-02-06 |