| NPI | 1447597562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHIL PETRUS Owner 915-577-0111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX PA03331) |
| Enumeration Date | 2013-01-09 |
| Last Update Date | 2013-01-09 |