| NPI | 1982065645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG J GAVIN Administrator 318-212-8951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: LA MD.199995) |
| Enumeration Date | 2016-03-09 |
| Last Update Date | 2016-03-09 |