| NPI | 1376185298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER OGBURN Credentialing/Contract Mgr 210-468-2015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2019-10-11 |