| NPI | 1699203349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CURTIS SHAIN CEO 502-420-8062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2018-04-10 |