| NPI | 1447812599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINA ANNE MANUELE Owner/Manager 662-417-5475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2019-07-02 |