| NPI | 1558475806 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY MILLER Co Manager 318-387-1059 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: LA 077368) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2020-08-22 |