| NPI | 1902105745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLON MANGAHAS Owner 636-942-2223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2007006296) |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2012-12-20 |