| NPI | 1427580448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLINT TOLMAN Administrative Director 844-654-3700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: UT 293281-1205) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2018-06-20 |