| NPI | 1891357760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCEE SCOTT Owner 772-260-5648 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2019-07-01 |