| NPI | 1528203957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD MICHAEL DOMANGUE Cmo 985-991-4457 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: LA 202018) |
| Enumeration Date | 2008-12-15 |
| Last Update Date | 2014-06-05 |