| NPI | 1649390584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY GEORGE CRICK Owner 270-827-3573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 20235) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 22605) |
| 208000000X Pediatrics (Licence: KY 35996) | |
| 208000000X Pediatrics (Licence: KY 3094P) | |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2010-04-16 |