| NPI | 1710204391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | L RUSSELL PET President 508-675-0089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Enumeration Date | 2010-04-22 |
| Last Update Date | 2010-04-22 |