| NPI | 1669921094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONETTE BRAGG Practice Administrator 386-878-3090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2016-09-27 |