| NPI | 1508101296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KORTNI FLYNN Owner 989-714-1839 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL 105149) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL 98264) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL 105149) | |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2012-12-07 |