| NPI | 1033395306 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONAS O MOEN C Eo 254-776-0001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2008-02-28 |