| NPI | 1902231178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD E. TILLEY Registered Agent 870-425-6235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2014-03-03 |