| NPI | 1639536600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA J SHEMLEY Office Manager 270-962-7305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: KY 1055) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: KY 44328) |
| 261QX0100X Clinic/Center Occupational Medicine (Licence: KY 1055) | |
| Enumeration Date | 2016-01-21 |
| Last Update Date | 2016-01-21 |