| NPI | 1154920577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINIQUE SANDERS Owner 725-234-2215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2020-10-19 |