| NPI | 1871623520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY P AMSHOFF A Thletic D Irector 502-538-4951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: KY AT445) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-08-22 |