| NPI | 1144340787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSIAH KELLEY LILLY Owner 304-925-2922 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: WV 11322) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2007-10-24 |