| NPI | 1871021550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENEANE MARIE WAKULA Office Manager 772-546-9591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2017-05-25 |