| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 133 Main St, Irvine, Kentucky |
| Authorized Official Name and Position | Jennifer Pelfrey (CO-OWNER/ADMINISTRATOR) |
| Authorized Official Contact | 6063462795 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 259 Hustonville KY 40437-0259 Ph: (606) 346-2795 | 133 Main St Irvine KY 40336-1084 Ph: (606) 346-2795 |
| NPI Number | 1447534490 |
|---|---|
| Provider Enumeration Date | 10/07/2011 |
| Last Update Date | 10/07/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447534490 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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