| NPI | 1023694262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA A CALLAHAN President 866-268-6609 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2021-03-18 |
| Last Update Date | 2021-03-18 |