| NPI | 1790346039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER OGBURN Credentialing/Billing Mgr 210-468-2015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2019-06-26 |