| NPI | 1205189594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAZIA SIDDIQUI Owner 765-714-4344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: IN 01059790A) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2022-07-21 |