| NPI | 1760185003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MAUPIN Owner 859-200-4513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2024-01-19 |