| NPI | 1326659236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA M GROTH Credentialing Specialist 904-223-3321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2022-09-26 |