| NPI | 1417386624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS WADE MORELAND Owner 772-257-5995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: FL 0S10340) |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2014-04-29 |