| NPI | 1487899472 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY M FORTNER Credentialing Coordinator 636-386-9224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2008-12-05 |
| Last Update Date | 2008-12-05 |