| NPI | 1245992262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA LUCKANISH Owner 484-919-1607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2023-12-15 |