| NPI | 1043812696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN K LOVELACE Billing/Credentialing 731-410-7719 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry |
| Enumeration Date | 2020-11-09 |
| Last Update Date | 2020-11-09 |