| NPI | 1922863067 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODY MICHAEL JOHNSON Medical Director 606-331-2521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2024-02-19 |