| NPI | 1376118208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORESAIR ANTON MACK Owner/Clinician 224-407-5019 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2021-05-24 |