| NPI | 1538673694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY EATON BOUSSERT Member 318-278-4292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2017-11-28 |