| NPI | 1396120820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERNIKA JACKSON Practice Manager 502-253-0505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2025-10-08 |