| NPI | 1982124582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVER JAY PENNY Managing Member 602-362-4747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP3300X Clinic/Center, Pain |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ OTC8621) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2022-07-21 |