| NPI | 1588108609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL SIDWELL Office Manger 859-268-8190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: KY 164848) |
| Enumeration Date | 2016-12-08 |
| Last Update Date | 2016-12-08 |