| NPI | 1902433832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAIA ALEES WALTON Medical Director 888-381-8556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 2080P0008X Pediatrics, Neurodevelopmental Disabilities |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2020-03-23 |