| NPI | 1316118326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAVONNA M LATTA Business Manager 4794-442-5437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: AR E4759) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2008-07-30 |