| NPI | 1083311005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL L. BOGGUS Provider 317-617-1498 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2023-02-09 |