| NPI | 1710392410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN WILLIAMS Responsible Party/Representative 502-544-1780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-10968) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2023-05-16 |