| NPI | 1083194237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOY J JOHNSON Director Of Contracting 731-507-0062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2018-08-17 |