Graduated: 2018
NPI: 1821571092
Practice Locations (2)
KENTUCKY MSO LLC
105 PRATHER PATH, SUITE 1 200
GEORGETOWN, KY 403249206
5025703785
CLARK REGIONAL PHYSICIAN PRACTICES LLC
129 STONE TRACE DR
MT STERLING, KY 403539386
8594986006
Source: CMS National Downloadable File, September 2026.