NPI | 1356052468 |
---|---|
Entity Type | Organization |
Authorized Contact | JASON CARNES LEWIS Owner 502-855-3919 |
Organization Subpart ? | No |
Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine |
Enumeration Date | 2022-12-09 |
Last Update Date | 2023-01-03 |