Organization
PARK STREET PARTNERS, L.L.P.
Active
Other names
CorpCare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD G. SOWELL (EXECUTIVE VICE-PRESIDENT)
(270) 745-1500
Entity
Organization
Contact information
Practice address
1110 WILKINSON TRCE, BOWLING GREEN, KY 42103-3402
(270) 796-3590
(270) 745-1156
Mailing address
1110 WILKINSON TRCE, BOWLING GREEN, KY 42103-3402
(270) 796-3590
(270) 745-1156
Taxonomy
Speciality
Code
Description
License number
State
261QC1800X
Corporate Health Clinic/Center
Primary
XXXXXXXXXX
KY
Other
Enumeration date
07/31/2012
Last updated
07/31/2012
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