| NPI | 1790055754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES FULNER Officer/Director 502-777-8128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology |
| 208600000X Surgery | |
| 208800000X Urology | |
| Enumeration Date | 2012-01-09 |
| Last Update Date | 2012-01-09 |