| NPI | 1164810271 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY GRECO Payer Enrollment Manager 223-341-8516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Enumeration Date | 2014-12-26 |
| Last Update Date | 2025-07-31 |