| NPI | 1235965401 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD CONRAD SHELTON Owner 636-442-5035 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2024-09-12 |
| Last Update Date | 2024-09-12 |