Organization
GREATER KENTUCKY WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY WAYNE BURNHAM (OWNER)
(606) 717-1018
Entity
Organization
Contact information
Practice address
101 RIVER DR, IRVINE, KY 40336-1117
(606) 717-1018
Mailing address
101 RIVER DR, IRVINE, KY 40336-1117
(606) 717-1018
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
—
KY
Other
Enumeration date
07/26/2011
Last updated
07/26/2011
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