| NPI | 1659551935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES A MOORE Owner 606-248-0090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2025-01-21 |