Organization
PRIMETIME INTERVENTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELENA OUTLAW (OWNER)
(606) 634-1471
Entity
Organization
Contact information
Practice address
20 ROYAL MELBOURNE LN, JENKINS, KY 41537-7512
(606) 634-1471
(606) 832-0397
Mailing address
20 ROYAL MELBOURNE LN, JENKINS, KY 41537-7512
(606) 634-1471
(606) 832-0397
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
06/03/2016
Last updated
06/03/2016
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