| NPI | 1942606454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY ROSE MCKENNA President 270-403-1106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: KY 3004091) |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2022-12-01 |