| NPI | 1073910709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID GOLDMAN Clinical Director 800-972-0716 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MD LC3716) |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2014-11-24 |