| NPI | 1134183510 |
|---|---|
| Former Legal Business Name | EASTDALE PSYCHOLOGY GROUP PC |
| Entity Type | Organization |
| Authorized Contact | ANNE M GREEN Coowner 319-358-9397 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2012-11-29 |