| NPI | 1710707765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI MCCORMICK Chief Treatment Officer 606-928-6648 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2024-10-15 |
| Last Update Date | 2024-10-15 |