| NPI | 1083855993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLEN MAYNARD Pa Manager 606-432-0168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY PA953) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KY PA953) |
| Enumeration Date | 2009-03-23 |
| Last Update Date | 2009-03-23 |