| NPI | 1548931249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VADIM PETROV-KONDRATOV Physician Owner 912-910-3777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2024-09-06 |