| NPI | 1922280015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REESON EARL FLORES Owner 502-491-0345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: KY 4863) |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2009-11-18 |