| NPI | 1174182596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIEL L. BONILLA Medical Director 928-600-6762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2019-06-10 |