| NPI | 1134520497 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON R. SPARKS Owner 539-664-4448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine |
| Enumeration Date | 2014-09-05 |
| Last Update Date | 2014-09-05 |