| NPI | 1558573188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROCHELLE R CANNON Administrator 386-274-0097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP3300X Clinic/Center, Pain (Licence: FL ME86188) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2023-03-07 |