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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. NASIRA MAH-JABEEN (DIRECTOR OF OPERATIONS)
(502) 579-0170
Entity
Organization

Contact information

Practice address
331 & 335 PRESTON ST, LOUISVILLE, KY 40202
(502) 384-3447
(502) 384-3447
Mailing address
333 S PRESTON ST, LOUISVILLE, KY 40202-1503
(502) 552-6064
(502) 384-3447

Taxonomy

Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary

Other

Enumeration date
01/12/2024
Last updated
11/04/2024
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