| NPI | 1629476700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILL CARTER Owner 606-420-4070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2014-12-05 |
| Last Update Date | 2015-08-28 |