| NPI | 1912329871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAM ELGHOR Owner 320-230-7788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2022-10-28 |