| NPI | 1336878909 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTAL WILSON Owner 502-876-6474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2024-01-10 |