Individual
AMANDA GRIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
125 S MAIN CROSS ST, LOUISA, KY 41230-1065
(606) 638-0938
Mailing address
PO BOX 726, LOUISA, KY 41230-0726
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/05/2019
Last updated
11/05/2019
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