| NPI | 1376160820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES SMIDT Owner 855-621-8250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2021-10-22 |