| NPI | 1649554759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON T KELLER Owner 731-884-3900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TN 1368) |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2012-04-26 |