| NPI | 1659024917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON CARNES LEWIS Owner 502-855-3919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2022-01-27 |