| NPI | 1144891359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLEY VICTOR Sole Owner 563-265-2722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2021-09-21 |