| NPI | 1750896635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN BRANNON Administrator 502-303-0919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2019-02-13 |