| NPI | 1962839845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARLES PERDOMO President 502-499-4156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: KY 36067) |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service (Licence: KY 39869) |
| Enumeration Date | 2013-10-08 |
| Last Update Date | 2013-11-18 |