| NPI | 1194924514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK EDWARD FARRELL Provider 208-705-3199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: ID M-6441) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2019-08-13 |