| NPI | 1376192294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELEY J BOOTH Physican / Owner 800-780-1220 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2019-09-04 |
| Last Update Date | 2019-09-04 |