| NPI | 1588832992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE ALAN MAXWELL Co Owner 208-323-6273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2008-02-19 |