| NPI | 1013525898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN DANE MARSHALL Owner 918-850-5147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2020-07-17 |