| NPI | 1245767672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISTY HOOKS Billing/Credentialing Supervisor 229-238-0265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2021-04-14 |