| NPI | 1245607589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK L VOLLARO President 866-954-8281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2015-08-21 |