| NPI | 1558811323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAINE LISNER Owner 859-400-0123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: KY 25368) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2016-10-05 |