| NPI | 1821643933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN TENNANT Dc 999-999-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2019-12-30 |