| NPI | 1124275565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEONEL KEVIN VANCE Owner 769-300-0730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MS 16855) |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2021-10-25 |