| NPI | 1942680194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIE MICHAEL FUSSELL Owner And President 304-241-5160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WV 2511) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2015-06-03 |