| NPI | 1568003887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY MATTHEW PHILLIPS Medical Director 458-205-1903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2019-10-08 |