| NPI | 1114496734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA WARD Credentialing Manager 757-340-3489 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2022-10-27 |