| NPI | 1619207628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL PACKARD Owner 888-395-4007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL me30779) |
| Enumeration Date | 2010-01-14 |
| Last Update Date | 2010-01-14 |