| NPI | 1598042343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRANCE DILLON Assistant Secretary 502-596-7220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0800X |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2022-04-25 |