| NPI | 1740802156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN SMITH Manager 502-244-9859 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2023-04-11 |