| NPI | 1659322808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD E CREQUE Owner 502-633-5565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: KY 36516) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2014-08-20 |