| NPI | 1558024950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDI JO CONLEY Insurance Billing Manager 424-298-8901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2021-10-21 |
| Last Update Date | 2021-10-21 |