| NPI | 1821307554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES B. DAVIS Executive Director 618-257-4644 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 207T00000X Neurological Surgery |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2013-03-06 |