| NPI | 1265702997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ELLEN DESRUISSEAU CFO 907-360-1566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: AK 935267) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2025-03-11 |