| NPI | 1629342985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHADWARD L. THACKER Soile Member/Owner 606-509-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 38711) |
| Enumeration Date | 2012-03-05 |
| Last Update Date | 2017-04-11 |