| NPI | 1144970419 |
|---|---|
| Former Legal Business Name | TRI STATE SPINE AND PAIN PROFESSIONAL CORPORATION |
| Entity Type | Organization |
| Authorized Contact | MIKHAIL ARTAMONOV CEO 570-972-6778 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2022-03-28 |