| NPI | 1124729405 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE JOSEPH LANGE President 332-334-6637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Additional Taxonomies | 261QI0500X Clinic/Center, Infusion Therapy |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2023-03-14 |