| NPI | 1912888033 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA ADAMS Chief Operating Officer 502-415-2836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2025-09-08 |
| Last Update Date | 2025-09-08 |