| NPI | 1710618160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH JOSEPH EADDY Physician 904-717-9625 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2024-04-10 |