| NPI | 1760717516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA KAYE HARSTON Business Owner 270-904-6160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: KY KY25936) |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2010-11-12 |