| NPI | 1235300765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONICA R FORMON Office Manager 870-972-0411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AR e1479) |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2009-12-15 |