| NPI | 1902418965 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL JOHN BONNETT Medical Director 844-455-2747 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QI0500X Clinic/Center, Infusion Therapy |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QP3300X Clinic/Center, Pain | |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2024-01-10 |