| NPI | 1881315075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD GARY KIMMEL Sole Member 817-897-7494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2022-09-07 |