| NPI | 1548704620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN HANSEN Administrator 731-343-8336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2016-12-08 |
| Last Update Date | 2019-01-24 |