| NPI | 1831837616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATANGRA MCINTOSH MCINTOSH Owner 863-860-4516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2022-05-23 |