| NPI | 1215346440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN K STOUDMIRE President/Owner 704-699-5296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: NC 200500827) |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2014-08-13 |