| NPI | 1508355181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH MENDEZ-VIGO Credentialing Manager 904-982-7447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2021-06-07 |