| NPI | 1174076822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN CLARK Physician 907-644-8446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AK 1033013) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2024-11-05 |