| NPI | 1871820290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANIE MARIAN HAGAN Owner/Operator 270-316-6117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: KY 016671) |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2009-11-05 |