| NPI | 1518107242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY R RYSULA Billing Manager 850-475-2668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME61690) |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2011-10-13 |