| NPI | 1639423577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK NEESE Member 502-435-9226 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251B00000X Case Management |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2019-05-21 |