| NPI | 1174355275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARTHUR HURST Manager 735-931-9267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| 251S00000X | |
| Enumeration Date | 2024-08-16 |
| Last Update Date | 2024-08-16 |