| NPI | 1972659704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA FRAZIER Provider Enrollment Specialist 919-256-0824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2007-07-24 |