| NPI | 1861724072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERI RUSSELL Credentialing Rep 502-727-7636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: KY 13477) |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2010-02-12 |