| NPI | 1679549083 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA BURKS Clinic Director 270-554-8373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KY 100605) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 100605) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2020-08-22 |