| NPI | 1619178100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE EDWARD PORTER Managing Member 662-841-8830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MS 18599) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2008-07-21 |