| NPI | 1720332042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE ANDERSON Practice Manager 270-901-3454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 37656) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 25071) |
| 208000000X Pediatrics (Licence: KY 37656) | |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2013-07-04 |