| NPI | 1124087549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY R MATHENY Treasurer 304-422-3904 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 208VP0000X |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2007-11-06 |