| NPI | 1194195941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY WILSON Owner 864-404-0433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2024-06-17 |