| NPI | 1720745151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACI-ANN MILLER Onwer 754-799-7991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2021-11-19 |
| Last Update Date | 2021-12-02 |