| NPI | 1710291752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD SANDVOS CEO 870-425-6212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine |
| 207L00000X Anesthesiology | |
| 207R00000X Internal Medicine | |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2013-08-16 |