| NPI | 1790504876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE MORGAN FOSBENNER Medical Director 267-374-6747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2024-10-07 |
| Last Update Date | 2024-10-07 |