| NPI | 1114276789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON LEWIS Owner/Medical Director 502-855-3919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: KY 42621) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2012-08-29 |