| NPI | 1518226521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY G RAROQUE Manager 866-620-5987 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX H6748) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2012-05-10 |