| NPI | 1013292317 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEREMY L SANDERS Owner Of Pa 512-329-5705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2015-05-18 |