| NPI | 1912720665 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATT ROGERS CEO 502-495-3665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RR0500X Internal Medicine, Rheumatology |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2024-11-01 |
| Last Update Date | 2024-11-01 |