| NPI | 1700235645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELEY J BOOTH Physician / Owner 800-781-1220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2023-12-18 |