| NPI | 1578628392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JOHN LIGHT CEO 502-244-5437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: KY 36355) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2020-08-22 |