| NPI | 1528265246 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLYDE E GLENN Owner 888-561-3380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 15747) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2022-11-29 |